Schneider v. Dunkirk Ice Cream

301 A.D.2d 906, 754 N.Y.S.2d 409, 2003 N.Y. App. Div. LEXIS 377
Appellate Division of the Supreme Court of the State of New York·Decided January 23, 2003·Published·Cited by 8 cases

Opinion

Spain, J.

Appeal from a decision of the Workers’ Compensation Board, filed July 13, 2001, which ruled that Liberty Mutual Insurance Company is responsible for claimant’s 1996 claim for workers’ compensation benefits.

Claimant was a truck driver for Dunkirk Ice Cream (hereinafter the employer) when, on October 6, 1993, he sustained a work-related injury to his back (hereinafter the 1993 accident). A C-2 report of injury was filed, and the employer’s workers’ compensation carrier, Liberty Mutual Insurance Company, paid for claimant’s medical expenses which consisted of chiropractic care for his lower back from Mark Kutner from October 1993 until November 1995, when that case was closed.

Meanwhile, in November 1994, Liberty ceased being the employer’s carrier and was replaced by Royal Insurance Company, which remained the employer’s carrier until August 10, 1996. On January 25, 1996, claimant sustained another back injury, which he promptly reported to his employer, in a second accident while working for the employer (hereinafter the 1996 accident). The employer correctly filed a C-2 report of injury with its current carrier, Royal, which was received on February 7, 1996, although it was not filed with the Workers’ Compensation Board until May 28, 1998. Claimant remained at work and the next day was treated by Kutner, who continued to treat him until January 1998. Unaware that the employer had a new carrier, i.e., Royal, Kutner continued to submit medical reports and bills (i.e., C-4 reports) for the 1996 accident to Liberty; Liberty apparently failed to recognize that a second injury had occurred in 1996 and paid the bills without objection for over two years. Claimant continued to work for the [907] employer until it ceased operations and closed in February or March 1996; he collected unemployment for approximately six months and, in March 1997, started his own truck company, but ceased working in February 1998 due to severe pain in his back. On April 27, 1998, claimant began treatment with Jeffrey Lewis, a neurosurgeon, who determined that he was totally disabled; claimant claimed lost wages from that date.

The C-4 reports submitted for medical services for the 1996 accident correctly listed the date of injury as January 25, 1996, and listed diagnostic codes which were not the same as those listed on the C-4 reports previously submitted for the 1993 accident, although the section designated for history or evidence of preexisting injury was left blank on the C-4 reports submitted for the 1996 accident. The statements of how the injury occurred were similar on the C-4 reports submitted for the 1993 accident and those submitted after the 1996 accident, both describing an incident in which a rear door fell off the truck; in the 1993 reports, it describes the injury-producing event as claimant trying to stop a falling door while, in the 1996 report, it relates that injury resulted when claimant picked up a door and put it back in the truck. Kutner’s C-4 reports for the 1996 accident were not filed with the Board or provided to Royal until sometime in 1998.

In January 1998, Liberty secured an independent medical examination of claimant related to the 1993 accident, which alerted it to the fact that claimant had actually sustained two different work-related injuries, one in 1993 and one in 1996. Shortly thereafter, Liberty filed a notice of treatment issues/ disputed bill issues to cease medical care related to the 1993 accident (form C-8.1A) and notices to reopen the 1993 case (form RB-679) and disputing medical bills (form C-8.1B), raising the issue for the first time that there was a new injury for which Liberty was not the proper carrier. The 1996 accident was assigned a separate case number from that assigned the 1993 accident, claimant filed a claim for compensation on April 10, 1998 with the Board, Royal received notice in May 1998 and the 1993 accident claim was reopened on June 10, 1998.1 A hearing was held on February 22, 1999 at which Liberty contended that, inasmuch as its policy covering the employer expired in 1994, it was not the carrier responsible for coverage of the 1996 accident. Royal argued that any claim against it was untimely under Workers’ Compensation Law § 28 based upon claimant’s failure to file a notice of claim with the Board [908] within two years of the accident. Claimant was the only witness called to testify.

The Workers’ Compensation Law Judge (hereinafter WCLJ) determined that claimant sustained a work-related injury to his back on January 25, 1996 for which Royal had received timely notice (the C-2 report received on February 7, 1996) and concluded that the claim had been timely filed pursuant to Workers’ Compensation Law § 28. The WCLJ reasoned that in paying claimant’s medical expenses, Liberty had acted as the employer’s agent in making advance payments under Workers’ Compensation Law § 28, foreclosing any defense by the employer or Royal based on claimant’s failure to file a timely claim. Upon Royal’s request for review, a panel of the Board reversed and held that Liberty was the carrier liable for the 1996 accident. The decision incorrectly states that Liberty was the employer’s carrier until July 1996, i.e., at the time of the January 1996 accident, and concluded that Liberty’s advance payments under Workers’ Compensation Law § 28 obviated any challenge to the timeliness of the claim.

Upon Liberty’s request for full Board review, the Board held that despite the fact that Royal was the carrier of record at the time, Liberty is responsible for the 1996 accident because, through its own fault, it made advance payments of compensation to claimant by paying his medical expenses.2 The employer and Liberty now appeal.

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Schneider v. Dunkirk Ice Cream, 301 A.D.2d 906, 754 N.Y.S.2d 409, 2003 N.Y. App. Div. LEXIS 377 (N.Y. Ct. App. 2003).

301 A.D.2d 906 (Schneider v. Dunkirk Ice Cream) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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